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Lunesta vs Ambien vs Sonata: Choosing the Best for You!

lunesta vs ambien vs sonata

Lunesta vs Ambien vs Sonata

Lunesta vs Ambien vs Sonata is a comparison of the the three zzz drugs (Z-Drugs) or sleep medicines, also called hypnotics.

Market Name

Medicine Name

Lunesta Eszopiclone
Ambien Zolpidem
Sonata Zaleplon

Lunesta, Ambien, and Sonata are non-benzodiazepine sleeping pills with some anxiolytic and muscle relaxant properties as well.

The exact mechanism of these drugs is not known. However, they exert their action primarily via a subunit of the GABA-Benzodiazepine complex

An Overview of Lunesta vs Ambien vs Sonata:

One of the major clinical differences between Lunesta vs Ambien vs Sonata is the duration of their hypnotic effect.

The duration of action is dependent on the terminal half-life of these drugs as shown in the table below:

Z-Drugs

Half-life

Sonata 1 hour
Amben 2.6 hours
Lunesta 6 hours

Sonata has the shortest half-life and hence the shortest duration of action. It is best to induce sleep in people with:

  • difficulty in falling asleep and
  • in those with frequent awakenings at midnight.

The sleeping effect of Ambien lasts for 6 to 8 hours which is sufficient for most people. 

Lunesta on the other hand has the longest half-life and its effects last the whole night.

Because of the differences in duration of action, Lunesta is more likely to be associated with prolonged sleepiness even during the daytime.

Sonata is least likely to be associated with morning sleepiness. Ambien may also cause morning sleepiness in people with impaired liver functions and in the elderly.

  • Effect of Food on Tmax for Lunesta vs Ambien vs Sonata:

Food delays the absorption of all the three Z-drugs. Food delays the time to reach the maximum concentration by about one hour for Lunesta and Sonata and 1.6 hours for Ambien [Ref].

Thus, it is important to not take these sleeping pills immediately before or after a meal. They should be taken just before going to bed.

  • Protein binding:

Ambien has a high-plasma-protein binding (90%) compared to Lunesta or Sonata (50 – 60%).

Thus, drug interactions and medical conditions where plasma albumin may be reduced should be considered when choosing any of the Z-drugs and preferring one over another.

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Comparing the efficacies of Lunesta vs Ambien vs Sonata:

Before comparing which drug is more effective, there is one main difference between Lunesta vs Ambien and Sonata.

The FDA labeling limits the consecutive use of Sonata to a maximum of 30 days and that of Ambien (Zolpidem) to 35 days. However, there are no such restrictions for Lunesta.

Thus, Ambien and Sonata are primarily indicated for transient insomnia while Lunesta is indicated for chronic insomnia in patients who require long-term medications.

  • Lunesta for Insomnia Treatment in the Elderly:

Lunesta was compared with a placebo and at different doses in individuals aged 65 to 85 years. It was given for 2 weeks and the response to treatment was assessed [Ref]:

Treatment Group

Response

Sleep Latency Both Lunesta 1 mg and 2 mg reduced the time to sleep onset after going to bed vs. the placebo
Total Sleep Time Lunest 2 mg increased total sleep time vs. placebo
Number of Awakenings Significantly reduced with Lunesta 2 mg vs placebo
Sleep Quality Improved
Sleep Depth Improved
Daytime Function Variables Improved

Lunesta 2 mg significantly improved all sleep parameters over a period of 2 weeks when administered to elderly patients with insomnia.

  • Lunesta 2 mg vs 3 mg for Insomnia:

A 6-week randomized trial was carried out to assess the safety and efficacy of Lunest 2 mg and 3 mg vs placebo.

Both Lunesta 2 mg and 3 mg resulted in significant improvements in the following parameters vs placebo:

Treatment Group

Eszopiclone 2 mg and 3 mg

Latency to Persistent Sleep Significantly reduced vs placebo
Sleep Efficiency Significantly improved vs placebo
Total Sleep Time of 7 hours or more 68% and 53% vs only 37% for placebo
Sleep Quality Significantly improved vs placebo
Depth of Sleep Significantly improved vs placebo

However, Lunesta 3 mg was superior to Lunesta 2 mg in reducing the wake time after sleep-onset.

  • Lunesta for 6 months in chronic insomnia:

Another long-term study evaluated the efficacy of Lunesta in a dose of 3 mg in individuals aged 21 to 69 years with chronic insomnia.

The results were in favor of Lunesta 3 mg. It improved all the sleep-related parameters in patients with chronic insomnia, including [Ref]:

  • Sleep Latency
  • Total Sleep Time
  • Number of Awakenings
  • Wake Time After Sleep Onset
  • Quality of Sleep
  • Next-Day Ratings

Unlike other hypnotic drugs, Eszopiclone  (Lunesta) can be used for insomnia beyond 4 to 5 weeks.

  • Zolpidem Vs Zopiclone for Chronic Insomnia:

Ambien in a dose of 10 mg vs Zopiclone in a dose of 7.5 mg were compared in one trial [Ref].

Moderate improvement in sleep quality was reported by 67.9% of the patients in the Ambien group vs 61.6% of the patients in the Zopiclone group.

Sleep-onset latency improved in 85.8% of the patients in the Ambien group vs 77.5% of the patients in the Zopiclone group.

Adverse events were reported by 31.3% of the patients in the Zolpidem (Ambien) group vs 45.3% of the patients in the Zopiclone) group. Bitter taste was the most common side effect observed with Zopiclone.

In addition, more patients in the Zopiclone group withdrew from the study vs Zolpidem.

  • Zolpidem Vs Zaleplon (Ambien vs Sonata) for primary Insomnia:

Zaleplon (Sonata) is an ultra-short-acting hypnotic drug while Zolpidem (Ambien) has a moderately longer duration of action.

In a study that compared the safety and efficacy of Zaleplon and Zolpidem in reducing the time to sleep (sleep latency) in primary insomnia, both drugs improved sleep latency.

However, Zalelplon (Sonata) resulted in a marginally greater reduction in sleep latency compared to Ambien (Zolpidem) [Ref].

Another study evaluated the effects of Zaleplon (Sonata), Zolpidem (Ambien), and Triazolam (Halcion) on psychomotor functions and memory.

It was observed that Zaleplon (Sonata) did not cause significant impairment in psychomotor functions and memory compared to Zolpidem and Triazolam [Ref].

Sonata was considered to be a safe sleeping pill compared to Ambien with no effect on memory and other psychomotor functions.

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Lunesta vs Ambien vs Sonata in a Nutshell:

Sonata is an ultra-short-acting hypnotic for sleep induction while Ambien and Lunesta are best for sleep maintenance.

Because of the shortest half-life, Sonata is less likely to be associated with next-day drowsiness and cognitive impairment than Lunesta and Ambien.

Ambien is best for sleep maintenance compared to Sonata. However, it may cause some degree of memory and cognitive impairment compared to Sonata.

Lunesta is the longest-acting drug. One of its main advantages is that it can be used for a prolonged period of time compared to Sonata and Ambien which are only recommended for up to 35 days (5 weeks or less).

Here is a table summarizing the PROS and CONS of Lunesta vs Ambien vs Sonata:

Z-Drugs

Pros

Cons

Lunesta  

  • Can be used for an extended period of time (beyond 5 weeks)
  • Best for Sleep Maintenance (Sleep time of 7 hours or more)
  • Very long-acting.
  • Next day drowsiness
  • Memory and Cognitive Impairment

Ambien  

  • Best for sleep induction and sleep maintenance (sleep time of 6 – 8 hours)
  • Moderately longer acting.
  • Next-day drowsiness can occur
  • Can cause memory and cognitive impairment
  • Not recommended beyond 5 weeks
  • Associated with significant drug interactions

Sonata 

  • Best for sleep induction (may be used with Lunesta or Ambien for frequent sleep awakenings)
  • Not associated with next-day psychomotor impairment
  • Not recommended beyond 30 days.
  • Not suitable for sleep maintenance

 

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What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

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